肺部感染产超广谱β内酰胺酶肠杆菌科细菌的危险因素分析  

Risk factors of pulmonary infections induced by extended-spectrumβ-lactamase-producing Enterobacteriaceae

作　　者：张博佳[1] 谈敏[2] 袁应华[3] 王昌惠[2] ZHANG Bo-jia;TAN Min;YUAN Ying-hua;WANG Chang-hui(Dept. of Infectious Diseases, Tenth People＇s Hospital, Tongji University, Shanghai 200072, China;Dept. of Respiratory Medicine, Tenth People＇s Hospital, Tongji University, Shanghai 200072, China;Dept.of Clinical Laboratory, Tenth People＇s Hospital, Tongji University, Shanghai 200072, China)

机构地区：[1]同济大学附属第十人民医院感染科,上海200072 [2]同济大学附属第十人民医院呼吸科,上海200072 [3]同济大学附属第十人民医院检验科,上海200072

出　　处：《同济大学学报（医学版）》2018年第2期117-122,共6页Journal of Tongji University(Medical Science)

摘　　要：目的探讨分析产超广谱β内酰胺酶肠杆菌科细菌(extended-spectrumβ-lactamase-producing Enterobacteriaceae,ESBL-PE)致肺部感染的危险因素。方法对255例肺部影像学证实肺部感染、痰培养提示肠杆菌科细菌生长的患者进行回顾性研究,分析产ESLB-PE致肺部感染的危险因素。结果医院获得性肺炎(OR:2.217,95%CI:1.135~4.331,P=0.020)、培养前经验性使用二种以上抗生素治疗(OR:4.664,95%CI:2.413~9.015,P<0.001)、培养前经验性使用广谱β内酰胺类抗生素(OR:2.223,95%CI:1.078~4.584,P=0.031)、既往脑卒中或脑部手术史(OR:2.504,95%CI:1.351~4.641,P=0.004)和年龄≥60岁(OR:2.606,95%CI:1.328~5.116,P=0.005)为肺部感染中产ESBLs肠杆菌科细菌的独立危险因素。结论患者初始感染状态和不恰当的经验性用药可能导致ESBLs感染风险增高,临床医生应根据患者具体情况,充分评估ESBLs感染风险,选用适当抗生素治疗。Objective To investigate the risk factors of lung infections with extended spectrum β-lactamase-producing Enterobacteriaceae（ ESBL-PE）. Methods A retrospective study was performed on255 patients with pulmonary infections, whose sputum culture indicated the bacterial growth of Enterobacteriaceae. The risk factors were analyzed on pulmonary infections with ESLB-PE. Results Hospital acquired pneumonia（ OR： 2. 217,95% CI： 1. 135-4. 331,P = 0. 020）,use of more than two antibiotics before sampling（ OR： 4. 664,95%CI： 2. 413-9. 015,P = 0. 001）,use of broad-spectrum β-lactam antibiotics before sampling（ OR： 2. 223,95%CI： 1. 078-4. 584,P = 0. 031）,previous cerebral stroke or brain surgery（ OR： 2. 504,95%CI： 1. 351-4. 641 P = 0. 004） and age ≥ 60 years（ OR： 2. 606,95% CI： 1. 328-5. 116,P = 0. 005） were independent risk factors of pulmonary ESBL-PE infections. Conclusion Patients with initial infection status and inappropriate empiric medication may lead to increased risk of ESBL infections,and clinicians should be aware of the risk factors for ESBLs infection and select appropriate antibiotics for treatments.

关 键 词：肺炎 超广谱 Β内酰胺酶 肠杆菌科细菌 风险因素 

分 类 号：R563.1[医药卫生—呼吸系统]